User:Lisakuil/sandbox

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I will be editing the Laryngopharyngeal Reflux article. I am hoping to make some significant changes to this article. First of all, I would like to make the introductory paragraph more cohesive and clear. Currently I find the discussion and connection of GERD confusing and I would like to clarify this section. Similarly, in the "Background" section of the article, it begins by discussing GERD instead of LPR, which I find confusing as well. This topic needs to be introduced in a different way. Additionally, references need to be added to the "Diagnosis" section, as well as more detail on the assessment tools used. Finally, I think a section on different medical professionals relevant to this disease would be helpful. Specifically, a section about Speech-Language Pathologists where the issues of voice are addressed.

I mainly added to the signs and symptoms and treatment section, also anything I added is in italics :) Lisakuil (talk) 00:12, 24 October 2017 (UTC)

Laryngopharyngeal Reflux

Laryngopharyngeal reflux (LPR),[1][2] also known as extraesophageal reflux disease (EERD)[3] refers to retrograde flow of gastric contents to the upper aero-digestive tract, which causes a variety of symptoms, such as cough, hoarseness, and wheezing, among others. It can be a relevant comorbidity of asthma.[4]

Although heartburn is a primary symptom among people with gastroesophageal reflux disease (GERD), heartburn is present in fewer than 50% of the patients with LPR. Other terms used to describe this condition include atypical reflux,[5] reflux laryngitis[6], silent reflux,[7] and supra-esophageal reflux.[8]

Signs and symptoms

Extraesophageal symptoms are the result of exposure of the upper aerodigestive tract to the gastric juice. This causes a variety of symptoms, including hoarseness, postnasal drip, sore throat, difficulty swallowing, indigestion, wheezing, chronic cough, globus pharyngis and chronic throat-clearing. Some people with LPR have heartburn, while others have little or none of these symptoms. This is because the material that refluxes does not stay in the esophagus for very long. In other words, the acid does not have enough time to irritate the esophagus.[9]

Additionally, LPR can cause inflammation in the vocal tract which results in the symptom of hoarseness. Hoarseness is considered to be one of the primary symptoms of LPR and “... can lead to functional complaints, including vocal forcing, forcing sensations, vocal fatigue, muskuloskeletal tension, and hard glottal attacks”[10] which may reduce communicative effectiveness for those with LPR.[11]  Additionally, patients try to compensate for their hoarseness by increasing their muscular tension. This can lead to a condition called muscle tension dysphonia which is a hyper-functional technique adopted in response to the inflammation caused by LPR. This pattern may persist even after the hoarseness and inflammation caused by the LPR has disappeared. Often a Speech-Language Pathologist will need to be involved to help resolve this maladaptive, compensatory pattern through the implementation of voice therapy[12].  Lisakuil (talk) 03:48, 21 October 2017 (UTC)--

Adults who are afflicted with LPR often experience the acrid taste of bile emanating from the back of their throat. This is also likely to be accompanied by a lump-like sensation in the throat, making it difficult to swallow. The throat may also seem to burn and breathing can be difficult. These symptoms are most often prevalent just after waking.[13]

LPR may also result in sinusitis and difficulty breathing.[14]

Treatment

Management of symptoms for patients within this subgroup of the GERD spectrum is difficult. Once these patients are identified, behavioral changes including weight loss and dietary changes are advised. Proton-pump inhibitors have been shown to be ineffective in very young children, and are of uncertain efficacy in older children, for whom their use has been discouraged.[15] When medical management fails, Nissen fundoplication can be offered.[16] While proton pump inhibitors may provide limited clinical benefits in some adults, there is insufficient evidence to support routine use.[15][17] Many studies show that proton pump inhibitors are not more effective than Placebo in treating LPR.[18] Some studies have pointed to a larger role of pepsin in causing damage to tissue, and of patients having had success with combination of higher dose PPI's and Sodium Alginate preparations (Gaviscon Advanced).

A study published in the medical journal JAMA in September 2017, A Comparison of Alkaline Water and Mediterranean Diet vs Proton Pump Inhibition for Treatment of Laryngopharyngeal Reflux[19], showed that dietary changes alone can produce symptom improvements that are comparable to proton-pump inhibitor drugs with none of the side effects. Craig Zalvan MD, the lead investigator for the study, stated that "...medication couldn’t be the only method to treat reflux. And recent studies reporting increased rates of stroke and heart attack, dementia and kidney damage from prolonged PPI use made me more certain."[20] The study outlines the role of the digestive enzyme pepsin in damaging the laryngopharynx and confirms that eating foods which are less acidic will reduce pepsin-related symptoms.

One way to assess treatment outcomes for LPR is through the use of voice quality measures[21]. Both subjective and objective measures of voice quality can be used. Subjective measures include scales such as the Grade, Roughness, Breathiness, Asthenia, Strain Scale (GRBAS), the Reflux Symptom Index, the Voice Handicap Index (VHI), and a voice symptom scale. Objective measures often used acoustic parameters such as jitter, shimmer, signal-to-noise ratio, and fundamental frequency, among others[21]. Aerodynamic measures such as vital capacity and maximum phonation time (MPT) have also been used as an objective measure[21]. However, there is not yet a consensus on how best to use the measures or which measures are best to assess treatment outcomes for LPR. Lisakuil (talk) 03:48, 21 October 2017 (UTC)--

References

  1. ^ Laryngopharyngeal Reflux, New York-Presbyterian Hospital, Weill Cornell Medical Center
  2. ^ Laryngopharyngeal Reflux (LPR), About.com
  3. ^ Kahrilas PJ (October 2000). "Maximizing outcome of extraesophageal reflux disease". Am J Manag Care. 6 (16 Suppl): S876–82. PMID 11184658.
  4. ^ Cazzola M, Segreti A, Calzetta L, Rogliani P (2013). "Comorbidities of asthma: current knowledge and future research needs" (PDF). Current Opinion in Pulmonary Medicine. 19 (1): 36–41. doi:10.1097/MCP.0b013e32835b113a. PMID 23114561.
  5. ^ "MARCI-Kids Midwest Acid Reflux Children's Institute". Retrieved 29 April 2010.
  6. ^ "Reflux Laryngitis: Background, Pathophysiology, Epidemiology". 2017-09-25. {{cite journal}}: Cite journal requires |journal= (help)
  7. ^ Koufman JA (2002). "Laryngopharyngeal reflux is different from classic gastroesophageal reflux disease". Ear, Nose, & Throat Journal. 81 (9 Suppl 2): 7–9. PMID 12353431.
  8. ^ Zerbib F, Stoll D (2010). "Management of laryngopharyngeal reflux: an unmet medical need". Neurogastroenterol Motil. 22 (2): 109–12. doi:10.1111/j.1365-2982.2009.01437.x. PMID 20067549.
  9. ^ "Laryngopharyngeal Reflux ("Silent Reflux"): The Basics". jamiekoufman.com. 2010. Retrieved 20 January 2014.
  10. ^ Lechien, Jérôme R.; Finck, Camille; Araujo, Pedro Costa de; Huet, Kathy; Delvaux, Véronique; Piccaluga, Myriam; Harmegnies, Bernard; Saussez, Sven. "Voice outcomes of laryngopharyngeal reflux treatment: a systematic review of 1483 patients". European Archives of Oto-Rhino-Laryngology. 274 (1): 1–23. doi:10.1007/s00405-016-3984-7.
  11. ^ Lechien, Jérôme R.; Huet, Kathy; Khalife, Mohamad; Fourneau, Anne-Françoise; Delvaux, Véronique; Piccaluga, Myriam; Harmegnies, Bernard; Saussez, Sven. "Impact of laryngopharyngeal reflux on subjective and objective voice assessments: a prospective study". Journal of Otolaryngology - Head & Neck Surgery. 45 (1). doi:10.1186/s40463-016-0171-1.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  12. ^ Thayer,, Sataloff, Robert. Reflux laryngitis and related disorders. Katz, Philip O., 1953-, Hawkshaw, Mary,, Sataloff, Dahlia, (Fourth edition ed.). San Diego. ISBN 9781597565387. OCLC 882106592. {{cite book}}: |edition= has extra text (help)CS1 maint: extra punctuation (link) CS1 maint: multiple names: authors list (link)
  13. ^ "Laryngopharyngeal Reflux Diet".
  14. ^ "Silent Reflux: A Hidden Epidemic".
  15. ^ a b Chang AB, Lasserson TJ, Gaffney J, Connor FL, Garske LA (2011). "Gastro-oesophageal reflux treatment for prolonged non-specific cough in children and adults". The Cochrane Database of Systematic Reviews (1): CD004823. doi:10.1002/14651858.CD004823.pub4. PMID 21249664.
  16. ^ Ford CN (September 2005). "Evaluation and management of laryngopharyngeal reflux". JAMA. 294 (12): 1534–40. doi:10.1001/jama.294.12.1534. PMID 16189367.
  17. ^ Chan WW, Chiou E, Obstein KL, Tignor AS, Whitlock TL (2011). "The efficacy of proton pump inhibitors for the treatment of asthma in adults: a meta-analysis". Archives of Internal Medicine. 171 (7): 620–9. doi:10.1001/archinternmed.2011.116. PMID 21482834.
  18. ^ Reimer, Christina; Bytzer, Peter (2008-02-01). "Management of laryngopharyngeal reflux with proton pump inhibitors". Therapeutics and Clinical Risk Management. 4 (1): 225–233. ISSN 1176-6336. PMC 2503658. PMID 18728712.
  19. ^ http://jamanetwork.com/journals/jamaotolaryngology/fullarticle/2652893
  20. ^ http://www.innovateli.com/study-nuts-plants-can-defeat-reflux-sans-meds/
  21. ^ a b c Lechien, Jérôme R.; Finck, Camille; Costa de Araujo, Pedro; Huet, Kathy; Delvaux, Véronique; Piccaluga, Myriam; Harmegnies, Bernard; Saussez, Sven (23 March 2016). "Voice outcomes of laryngopharyngeal reflux treatment: a systematic review of 1483 patients". European Archives of Oto-Rhino-Laryngology. pp. 1–23. doi:10.1007/s00405-016-3984-7. {{cite web}}: Missing or empty |url= (help)

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